This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The possibility that culture-specific altitudes and beliefs affect BRCA-decision making among African-American women has been raised by several studies. Mistrust of the medical community, fear of stigmatization and fatalistic attitudes towards cancer have been cited as barriers to testing among African American women. However, standard genetic counseling does not specifically address these culture-specific concerns. This may explain why standard genetic counseling has been less effective for African American women than for Caucasian women. In addition, little is known about the impact of genetic counseling on BRCA decision-making among African American breast cancer patients. It is important to understand which factors affect BRCA counseling/testing decisions among breast cancer patients. The goal of this project is to develop and evaluate the impact of culturally tailored genetic counseling on patient decision-making regarding BRCA testing and subsequent cognitive, emotional, and behavioral outcomes. We propose a randomized trial among newly diagnosed African American breast cancer patients in which we will compare standard genetic counseling (SGC) to culturally tailored genetic counseling (CT-GC).